The Roux-en-Y Gastric Bypass (RYGB) is the most successful bariatric procedure. Despite its successes, a growing number of patients who undergo RYGB present with clinically significant weight regain in the years following their procedure. Anatomical etiologies have been often implicated in this weight regain as either an enlargement of the gastric pouch or gastrojejunostomy, or the presence of a gastro gastric fistula leading to loss of caloric restriction. Surgical or endoscopic revision is an effective means to address this. Behavioral problems can also lead to poor results if patients do not adhere to strict dietary and lifestyle regimens following their procedure. Poor dietary compliance needs to be addressed with behavioral and nutritional counseling at a multidisciplinary clinic. Mental health is an often forgotten etiology for weight recidivism. Especially in high-risk patients – patients with personality disorders and addictions – simply recognizing the possibility of mental health problems during a preoperative assessment is a good start. Lastly, gut hormone imbalances including ghrelin and insulin can lead separately to increased appetite and significant hypoglycemia respectively, which can theoretically lead to RYBG failure. However, more research needs to be devoted to this area in order to be fully comfortable with making a conclusion. Overall, successful strategies for the management and recognition of weight recidivism following RYGB is important as these patients make up an important and growing segment of any bariatric practice.
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